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Posts published in November 2018

Rip off the bandaid


I hear the Idaho Department of Health and Welfare wants to wait until January 2020 to start enrolling people in the newly expanded Medicaid eligibility passed under Proposition 2 this last election. I’m sorry, but this is a pressing need. You state workers will need to git ‘er done.

Here’s why. Idaho has a taxpayer funded system, conceived way back in territorial days to pay for folks who need medical care but can’t pay for it. This is the county indigent health care system. It seemed to work OK for maybe a hundred years, but then small counties realized they could be bankrupted by one premature baby. So, the state Catastrophic Fund was conceived and now any bill over $11,000 goes on to the state. These county property tax dollars come to approximately $25M for all the counties and another $25M in state income taxes.

This system has propped up our small (and big) hospitals for too long. It needs to go. The sooner we get Idahoans enrolled onto health insurance, the sooner we can put this 19th century health care payment system in the dust bin. Git ‘er done.

I have questioned our new governor’s backbone. But this is just ripping off a band aid. We can do this; c’mon Brad.

Sure, there will be work to do. Folks who are now on the exchange but who would newly be eligible for Medicaid will need to be transitioned. That’s work the DHW will need to do sooner or later. We have a good number on this. Maybe 12,000 Idahoans could be affected. But there is another troubling number.

As the County indigent and CAT Fund costs have risen in the last couple years (since Trump and the repeal of the individual mandate) we are finding that more and more folks who are getting Idaho taxpayer funded indigent payments for their health care emergencies would not have been eligible for Medicaid. They make enough to buy insurance on the exchange. They just have chosen not to. But then they fall off a ladder and we pay for it. OK, they will be bankrupt, liens filed, but why can’t we make them enroll in an affordable health insurance plan. Maybe some folks like being free riders.

In my second year of medical school my first daughter got very sick and needed a complicated and life-saving surgery. My student health insurance wouldn’t cover it because it was due to a congenital (preexisting) condition. But the hospital and the surgeon did that surgery and we never got a bill. We benefited from their charity and I am to this day thankful to the point of tears for their generosity. But it meant I rode the system for free. And I resent that.

We all need to pay a share for the care we get. Idaho’s current system does not encourage people to think ahead, consider that they are part of the greater good. Instead we are encouraging people to play roulette, or more likely, Russian roulette with their health and our tax dollars. We are encouraging people to try to see if they can get a free ride. This makes no sense.

C’mon Idaho, Git ‘er done.

With eyes tightly shut


Most objective historians consider the Iran nuclear deal to be a signature achievement of the Obama Administration. It was not a perfect deal, but it satisfied most of the concerns of most of the nations upon most of the terms that most of the participants considered to be important and which all could then embrace. It was accomplished at a historic table that had never been assembled before. And all of the nations agreed that it was a brilliant diplomatic feat that clearly belonged to the United States, attributable in substantial part to the skill of Secretary of State John Kerry and the international leadership of President Barack Obama.

So, with his eyes tightly shut and his fingers plugging both ears, Trump stepped right up to kill the deal.

After refusing to admit that Iran was in full compliance with all terms of the agreement, and against all advice from the moderate voices from everywhere, Trump abruptly announced in May of 2018 that he was pulling the United States out of the deal. Trump followed this in early November with the re-imposition of stringent economic sanctions against Iran. The thinking, as announced by Trump, is that this will force the Iranian leaders to come back to the table and agree to a stronger agreement.

Never mind that strict sanctions have been tried before and seldom work. Never mind that so far, there has been no indication of any interest by Iran in cooperating with any of Trump’s unilateral demands. Never mind that so long as the present Ayatollah remains as supreme leader, there is little likelihood of any change, no matter what the more moderate voices might want.

The tragic consequence is that Trump paid no attention to what Hassan Rouhani, the moderately inclined, Scottish trained lawyer who is the current president of Iran, had managed to accomplish on his end in bringing about the adoption of the deal by Iran. Trump seems to ignore or be oblivious to the progress that has been made within Iran and to the consequences to that progress that will probably result from his actions.

Rouhani had been the lead negotiator for Iran during the negotiations of 2003-2005, when a temporary suspension of the nuclear program was arranged. He resigned from the effort in 2005 when the ultra-conservative hard-liner Mahmoud Ahmadinejad was elected president of Iran. In 2013, Rouhani beat the conservative successor designated by Ahmadinejad to become the seventh president of Iran. He then convinced the supreme leader to stay out of the way to the renewed negotiations for a nuclear compromise. He installed the more moderate Mohammad Javad Zarif as Iran’s foreign minister, to head the negotiations for Iran. The sudden moderation in the leadership of Iran, away from the hawkish doctrinaire of Ahmadinejad, and with the tacit agreement of the supreme leader to keep silent, the way was paved for the negotiations to be restarted.

Although Rouhani had faced stiff resistance from within Iran throughout the years of negotiations, with the announcement of a successful agreement and the anticipated cessation of economic sanctions, Rouhani’s popularity in Iran shot up. He was re-elected president over the more conservative candidate backed by the Ayatollah in 2017. For the first time in over 35 years, ever since relations with Iran were cut off in 1980, a pathway appeared for the possibility of reopening discussions with the west.

It was only an expectancy, for the supreme leader, the Ayatollah Ali Khamenei, is a hard line, hawkish cleric who, under the complicated political structure that no one in the west seems to understand, can exercise controlling influence over the presidency and parliamentary operation of the country at any time. Rouhani had persuaded the Ayatollah to step aside during the negotiations, but the ultra-conservative factions continues to be strongly critical of any deal made with the international powers. But at least the formal agreement was a step in the right direction.

Trump’s action ends any chance of this progress. Although Rouhani continues in his efforts to work with Russia, China, and the European powers to salvage any part of the deal that he can, and he has announced that Iran would continue to adhere to the requirements of the deal, Rouhani’s domestic opponents are clamoring for his resignation. One conservative news outlet likened him to the disgraced former British prime minister Neville Chamberlain. Despite the steps by the E.U. and other nations to uphold the deal, Iran’s economy is in severe stress. Iran’s currency has plunged in value against the dollar, bringing huge price increases in everything from cell phones to medical supplies. Many European companies are abandoning Iran rather than risk being curtailed by the United States. Given the rift between the Rouhani faction and the conservative followers of the Ayatollah, it is unlikely that any meaningful capitulation to Trump’s demands will occur.

The huge problem is the lack of a realistic, attainable declaration of policy by the United States towards the middle East. This whole thing was a hipshot from Trump without listening to any advice and without any evaluation of consequences. His foreign policy for the Middle East is so muddled with exceptions and inconsistencies as to be unintelligible. Trump’s declaration to Iran is an unrealistic statement of demands – it is not an invitation to negotiate, it is a demand for capitulation, and one that most observers predict is destined to fail.

So much remains uncertain. What is our policy towards Europe going to be as events unfold in Iran? What will we do if the European allies do not back the U.S. but continue to work against us to maintain open trading channels with Iran? Will the U.S. actually apply sanctions against its own allies if this happens? What of the waivers that the U.S. is granting (to South Korea, Japan, India, China, Taiwan, and Turkey, among others) – what is the basis for these exemptions and how long will these last? What will the reaction be of those not receiving waivers? With the sanctions and exceptions, and the workarounds coming out of Europe, it is obvious that there is going to be a ton of money to be made – some legitimately and barrels full under the tables. Is anybody watching the money?

Unless Trump is persuaded to change direction and moderate his demands, it appears the inevitable result will be an unstable Iran in the midst of an unstable middle East, with the same problems we face in North Korea, only worse. The economic impact of the continuation of sanctions by the United States, without participation by the rest of the Western powers, will serve only to impoverish Iran, drive an impenetrable wedge into relations with the United States, and cement relations with Russia and probably China.

The upshot of it all? It is a mess, and unlikely to improve anytime in the foreseeable future.

Advance care


The old saying about the certainty of death and taxes is not entirely true anymore. A talented tax lawyer can help some legislatively-favored individuals and businesses to avoid paying taxes.

On the other hand, nobody has yet figured out a way to escape mortal death. But even with that certainty staring them in the face, way too many people do not plan for their own departure from the living.

According to Honoring Choices, an Idaho non-profit dedicated to advanced care planning, 85% of Idaho adults think it is very important to choose their own end-of-life treatment options, but less than half have completed an advance care directive. Unless those choices are documented for health care providers, they may well be disregarded.

As a lawyer and judge, I have witnessed too many family tragedies resulting from people who do not get around to writing a will or designating a trusted friend or relative to carry out their end-of-life decisions regarding medical care. Conflicts among survivors could easily have been averted by writing a simple will or signing an up-to-date directive for medical care.

We each have it in our power to say what medical treatment we want or do not want as we approach death, and to appoint someone to carry out those wishes when we are no longer competent. We just have to quit procrastinating and get it done.

Honoring Choices and a broad coalition of interested parties, including the Idaho Hospital Association and Idaho Department of Health and Welfare, want to remedy the problem. The coalition will seek legislative funding to help educate the public about the vital importance of end-of-life planning, assist people in making advanced care medical directives, and set up an up-to-date registry of directives that can be used by doctors and hospitals around the state.

A primary objective of the program is to increase awareness of the need for adults of all ages, not just seniors, to get their wishes documented. And to let them know the unfortunate consequences of failing to do so. A wider range of interested parties--insurers, businesses, veteran groups, to name a few--can be enlisted to spread that message and get people motivated to document their wishes in an advance care directive.

Equally important is establishing an electronic registry where directives can be filed, updated and available when and where they are needed. Having some health problems of my own in 2017, I was asked numerous times at numerous health provider offices for a health care directive. You either took in the one you did several years ago or filled out a new one. Many folks have any number of directives sitting around in provider offices, bearing different dates and often containing conflicting information--a situation ripe for confusion.

A person may currently file a directive with the Secretary of State but few do. The ones that are filed can become outdated and are hard to access. The Secretary of State supports moving the registry to Health and Welfare where it would be continually updated and made accessible by health care providers around the state (with the maker’s consent). That would help to ensure that end-of-life treatment choices are known and honored.

Advance directive forms are available on the websites of the Idaho Secretary of State and Honoring Choices Idaho.

Jim Jones’ past columns can be found at

P-I-N it


Our recent national election contained the most outright, in-your-face cheating and lying of any in my lifetime. Just flat-out scandalous and, at times, illegal behavior. We’ll be living with the after effects for a long, long time. But, it may be just the precursor of the next one. And the next. And the next.

In state after state, the Republican Party - or what’s left of it - was the prime ruinous sponsor and leading miscreant. There may have been some Democrats flouting ethics and laws in some places. But, overwhelmingly, Republicans outdid themselves in despicable, lying behavior. Some are still at it.

The Republican candidate for U.S. Senate in our neighborhood looked straight at the TV camera in her commercials and told of the times she had voted to “protect pre-existing conditions for all Arizonans.” But, her votes in the U.S. House of Representatives, more than 40 of them, were to kill ACA (Obamacare) and some specifically to erase pre-existing conditions. She lost by less than two-percent. Nearly half of all voters apparently believed her.

That’s one case. Across the country, thousands of misleading, false or outright bogus claims and gross behavior. Names like Scott, Kemp, DeSantis, Anderson, Rohrabacher, Hunter, Akin, Kobach, and many more tried every lying trick-in-the-book. Some still are.

Many GOP efforts were to disenfranchise voters - make getting to the polls (especially in Dodge City, Kansas) nearly impossible. Or, legislating Native Americans out of the process. Voting machines with no power cord or were inoperable when installed. Some switching votes electronically. Overseers who were candidates themselves rigging outcomes. (Kemp and Kobach.)

Republican gerrymandering, in some places, meant a Democrat had get more than 60-percent to win. (S. Carolina and Alabama.)

Candidates are who they are. Some qualified. Some not. Some honest. Some not. Too many of the latter - not enough of the former. With the current lack of trust in both national parties, getting better, more qualified people to run is nearly impossible. That’s got to be a priority in 2020.

But, it’s gerrymandering and blocking voters that’s so heinous. Republicans, in many legislatures, used the 2000 census to twist, splice and draw voting districts to their benefit. Now, Democrats say, if they’re in the majority in 2020, they’ll be more honest. I’d like to believe that. But, I don’t. The most accurate description of political power I’ve ever been told was “When they’re in power, they do it to you; when you’re in power, you do it to them.” From an Idaho Democrat.

Several states blocked registered voters - especially Black, Hispanic, Native American - by all sorts of contrived schemes. More than any other factor, that needs to be addressed.

Oregon, in so many instances a leader in creative thinking, has some excellent approaches. One is “motor voter” registration. Register your vehicle and you’re automatically registered to vote. Parties assigned randomly. If you don’t like the assignment, change it. It’ll take several generations to reach 100-percent but, eventually, all Oregonians will be registered voter.

Also, as in Oregon and several other states, voting by mail should be federal law. I realize there are still people who like to go to a polling place. I’m one. I always felt a bit prouder when the little gray-haired lady announced for all to hear, “Barrett Rainey has voted.” But, like so many other things, times have changed. Voting by mail is one of those changes. There are some wrinkles to work out but they’re not insurmountable.

Do away with signatures on ballots. Assign each voter a PIN - personal identification number. Banks worldwide use ‘em. All credit card outfits use ‘em. They know within seconds when one of us hundreds of millions of users buys lunch anywhere in the world. Instead of laboriously checking signature authenticity - which in my case is impossible - check the PIN by high-speed scanner. Cut down or eliminate recounts.

Use a standardized national ballot format. Leave flexibility for states to enter necessary information. But, format all the same. In Florida, a U.S. Senate seat hinges on the way one county laid out its ballot with that race separated from all the others. Exit polling shows some people didn’t see it.

Require all counting to be done electronically. Standardize machines.

There are many more ideas out there. But, the plain fact is, we can’t keep doing things as we are. We can’t do much about political parties or individuals who want to lie, cheat, block and steal. But, no large corporation would run a national business the way we run the most important element of our democracy: voting.

We need our ballots handled accurately and treated with the certainty that our most basic, guaranteed freedom requires. Leaving it to political parties is not the best way to assure that.

Many things must be changed. Updated and streamlined. One of those things seems a natural: “P-I-N it.”

Idaho Weekly Briefing – November 19

This is a summary of a few items in the Idaho Weekly Briefing for November 19. Would you like to know more? Send us a note at

We're at work trying to make the Briefing a free-access publication through contributions. See our donation site at IndieGogo.

Work has started on developing a new Little gubernatorial administration, and the Otter Administration was caught up in discussion about a possible flawed education contract. Meanwhile, legislators met in North Idaho and pondered their leadership lineup for the coming legislative session. Just ahead this: A relative quiet, with Thanksgiving anchoring the week.

Governor-elect Brad Little has named Zach Hauge as his Chief of Staff. Hauge served as Little’s campaign manager during the 2018 primary and general elections. Before joining the campaign, Hauge was Vice President at the Idaho Association Commerce and Industry.

The U.S. Department of Energy’s Idaho National Laboratory continues to demonstrate its commitment to using small businesses by achieving all its small business goals for the sixth consecutive year.

Legislation to extend the Secure Rural Schools program by one year, through Fiscal Year 2019, has been introduced by Senators Mike Crapo and Ron Wyden (D-Oregon). The Secure Rural Schools and Community Self-Determination Act (SRS) was first introduced in 2000 to assist counties containing tracts of federally-owned land that is tax-exempt.

Idaho’s seasonally adjusted unemployment rate stayed at 2.7 percent in October, unchanged from September and continuing at or below 3 percent for the 14th consecutive month. The state’s labor force – the total number of people 16 years of age and older working or looking for work – was essentially unchanged since July at 853,444.

Boise residents are invited to delve into the issue of housing affordability as part of the City of Boise’s third round of Community Conversations on Growth on November 29 and December 1.

Governor C. L. “Butch” Otter said on Novmber 16 that he was granting a pardon to Aaron M. Bonney, a former Elmore County felon who was convicted in 1997 and served a 6-month rider for the statutory rape of his then, under-age girlfriend. At the time of the crime, Bonney was 18 years old and the victim was 15.

Micron Technology, Inc., an industry leader in innovative memory and storage solutions, today introduced the industry's first 1TB automotive and industrial grade PCIe NVMe™ solid state drive in BGA and 22x30mm M.2 form factors at Electronica 2018.

IMAGE The Idaho Association of Counties held its fall county officials institute at Idaho Falls on November 15. (image/Idaho Association of Counties)

Little needs his own team


Idaho Gov.-elect Brad Little has some big decisions to make. In the next few weeks, he'll need to put his stamp on a state budget that will spell out how he proposes to implement the Medicaid expansion initiative supported overwhelmingly by the state's voters last week.

Presumably he'll want to, at least at the margins, differentiate his proposals for education funding from those of his longtime boss, retiring Gov. C.L. "Butch" Otter. Maybe he'll propose a grocery tax repeal and a way to pay for it. Additionally a major challenge for the governor-elect is the perception, and remember perception is reality in politics, that he is simply gearing up to preside over Otter's fourth term.

There is a way to immediately change that perception and it involves how Little will stock the leadership ranks of state agencies. The new governor has two choices: He can tinker at the margins or he can clean house. He should clean house. Not doing so would be a big mistake for one simple reason.

Every governor, whether one that is succeeding a member of his party as Little will be, or taking over from the other party, has one clear moment when he (or we can hope someday soon she) can place a dramatic imprint on state agencies. This is such a moment for Little, a guy who has long prided himself on being a student of government, a kind of cowboy boot-wearing policy wonk steeped in the details of governing in a way that Otter never was.

Idaho has, all things considered, a relatively weak governor model. The governor doesn't directly appoint some of the most important state agency heads. A governor can have influence, but has no direct appointment authority over the departments of Transportation, Correction, Fish and Game, Lands or Parks and Recreation. Nevertheless what he can control is very important: the state Commerce Department, Health and Welfare, the departments of Administration, Labor, Insurance and Finance, the state personnel chief and the critical job of state budget director.

One can only imagine that Little, still basking in his decisive win on Election Day, has discovered just how many new best friends he now has. Half the GOP members of the Legislature - a conservative estimate - lust after an appointment to a state job, even if the outrageous perk of receiving a big jump in state retirement benefits may soon go away. For many legislators, snagging the good salary and benefits that go with being an agency director has to look pretty good.

Many of the current occupants of these state jobs - all appointed by Otter - will be working overtime to hang on to their positions. The natural tendency for most new governors would be to take the path of least resistance and keep a bunch of the Otter crowd. They're loyal Republicans, after all, and many contributed to Little's campaign. They'll pledge their fidelity and most will want Little to succeed. But Little can't - or won't - shape a new version, his vision, without new people, his people, in key positions.

My old boss, Cecil D. Andrus, lived this lesson in 1986 when he was preparing to succeed fellow Democrat John V. Evans in the governor's office. Evans, a good man and still an underrated governor, had assembled a good team and many of them wanted to stay on into a new Democratic administration. Andrus knew better. He imposed a rule during his campaign that he would accept no contributions from staffers in the Evans administration. He wanted no implied understanding that someone from the outgoing regime might curry favor with the new crowd, while hoping for a job. Andrus angered more than a few people, fellow Democrats mostly, when he made it clear that he was cleaning house. With only a couple of exceptions, he brought in an entirely new cast of state government leaders, people loyal to him, people sharing his vision, people understanding his priorities, people who knew he was the boss.

Little's immediate staff - a chief of staff, a press secretary, counselors on key issues - will constitute a critical part of his team. He should pick them wisely from among people he knows, trusts and is confident will serve him - and Idaho citizens - with diligence, energy and, as Franklin Roosevelt famously insisted, a "passion for anonymity."

Beyond his immediate staff, Little would be well advised to put his own person in charge of economic development at the Commerce Department. He should install a seasoned administrator at the Department of Administration, an incredibly important agency that handles everything from computers to risk management, and a place where more than one governor has been tripped up. Most of society's problems land daily on the desk of the director of the Department of Health and Welfare and the director there best be a person the new governor can both trust and personally hold accountable.

It's no knock on the Otter crowd that a new governor should want and is entitled to his own team. There are lots of names on doors in state government, but only one name on the ballot. Gov. Little will send a signal about how he'll run state government by the personnel decisions he makes between now and Christmas. If he's smart he'll make a clean sweep. He'll start fresh and from day one be in a position to hold his own people accountable. He'll never have a second chance for a new beginning. He'll never have a second chance to have his own first term rather than Otter's fourth term.

Johnson was press secretary and chief of staff to the late former Idaho Gov. Cecil D. Andrus. He lives in Manzanita, Ore.

Prognosis Idaho


The just-ended North Idaho Chamber of Commerce tour for legislators is a biennial tradition, but the word emanating from the first gathering of incoming lawmakers is about an unusual subject as a primary topic.

Taxes and budgets are a little more to the norm. This time something else got a lot of attention, not least in the incoming governor’s address: Health care.

It makes perfect sense, what with the passage of the Medicaid expansion - Proposition 2 - ballot measure only days ago.

Some legislators will be inclined, or even committed, to oppose it and try to kill it. They’ve had the numbers to do that in legislative sessions reaching back almost a decade; hence the arrival of the ballot issue.

But will they try to bury it again in 2019?

Legislators have reversed ballot issues before. They heavily modified at least (some would say gutted) the One Percent initiative of 1978. They outright reversed a term limits issue in the early 90s.

Still, before too eagerly taking the knives to Medicaid expansion, legislators may want to pause a bit. I’ll leave to others to discuss the impacts on the health of actual Idaho citizens, important as that is. Here, I’ll just toss out for consideration a few political facts.

Expansion did not pass by a little. It passed by a lot: 60.6 percent - a landslide.

And it was widespread. Because of the requirement (legislature-imposed) that ballot issues must demonstrate substantial support in legislative districts all over the state, there was in fact support for Prop 2 all over the state.

The top three counties in levels of support - Blaine, Teton and Latah - could be explained away by critics as places that do have significant Democratic bases. And that’s true. But Valley County, which to date is strongly Republican, supported it 67.3 percent. Twin Falls County backed it 58.2 percent, Bonneville 57.4 percent, Canyon 56.8 percent, Payette 56.6 percent. If Idaho has a localized beating heart of movement conservatism you could probably best place it at Kootenai County, and even there it passed, albeit narrowly, at 50.4 percent.

Of Idaho’s 44 counties, just nine opposed Prop 2, but none overwhelmingly: Its weakest county was Jefferson, and there it received about 41 percent support.

I skipped the most significant county. From a standpoint of raw politics, the most important was Ada County, where Prop 2 passed with 69.7% - and that’s county-wide, not the city of Boise, but Meridian, Kuna, Eagle and Star as well. All but four precincts out of more than 140 approved it.

Ada is important not just because it is the largest county, accounting for more than a third of the Idaho general election vote. And not just because it is growing rapidly, while most of the lower-support counties are growing slower.

It is also important because Ada County west of Boise is where Republican dominance is most critically being challenged, where in this year’s election breaches were found, on the Ada County Commission (two seats flipping to Democrats) and in legislative District 15 (two seats at least flipped there). Maybe the Democratic push goes no further. But know this: It can progress in 2020 if its candidates have good ammunition in hand, and legislative reversal of Prop 2 would be some of the strongest ammunition they could have.

The national evidence this year is that health care is a big issue; many of the newly-arriving Democrats to the U.S. House campaigned more heavily on that than on anything else. There’s no reason it can’t be potent in Idaho next time around as well.

Republican legislators might be able to round up the votes to reverse or gut Medicaid expansion at the Statehouse. But they would be well advised to consider all the consequences, political included, if they do.

Owning our health


The campaign to expand Medicaid health insurance eligibility in Idaho brought some broad health policy questions to the forefront. I am thankful we are having these discussions now; we have put this off for a long time.

One of the recurring counter arguments I heard when talking to voters was how “giving people a free handout” (Medicaid health insurance) made the recipients less likely to be responsible. This is the “moral hazard” argument that is well-studied and documented in economics. I’m not sure why this argument doesn’t apply to employment-based insurance also, but I get the rub. We all want people to be responsible and any program that might discourage responsible behavior should be scrutinized.

So, let’s scrutinize. I’m sorry if this gets uncomfortable. I’ll put on the gloves and you’ll need to bend over. You see, I am a doctor.

When I first meet a patient (before the gloves and bending over) I ask them questions about their symptoms, their medical history. One of the many questions I ask is phrased carefully: “What medicines do you take?”

Approximately 2/3rds of the time the patient response is phrased: “They’ve got me on a pill for my blood pressure, and they have me take a cholesterol medicine.”

I believe the words we use can often reflect how we think about things. In this case, “They have me on” suggests, I believe, the patient feels little involvement in the commitment to take a medication. In fact, the phrase suggests they are forced to take it, like “They have me in solitary confinement.”

When I can have the time, I encourage patients to say “I take a medicine for my blood pressure. I take XYZ for my cholesterol.” I believe in promoting ownership in our health. The passive, unengaged patient is not healthy.

I have no sense that people on Medicaid, Medicare, VA (that is, government-funded) benefits are more likely to use such phrasing. In fact, I have no evidence that such language is in fact related to a sense of disengagement with one’s health. Maybe you can ask yourself how you feel about the medications you take and the language you use to describe them.

If we can promote engagement in responsible behavior, engagement in our health, we may in fact promote better health. Private insurance companies spend a good deal of money with programs like this. In some plans, premiums are lower for people who participate in exercise, weight loss, healthy diet, smoking cessation. The hard part about all these programs is that the return on investment is probably 10-20 years out, and people change health insurance companies every 3 years, so the company rewarding the behavior doesn’t receive their return on investment.

I’m all for promoting healthy behaviors. But the best way I have found to do this is with direct interaction with a person, be that doctor-patient, or friend to friend. Governor Otter started building this plan 6 years ago with the Patient Centered Medical Home model for primary care in this state. It is an ongoing and successful model for healthy primary care relationships that could have leverage to change behavior.

I can’t believe someone writing a law in Boise will suddenly make people change their attitude toward their own health. But I can sure see them trying. Without gloves on.